Combat triage and mass casualty management

Abstract

Although much of this book focuses on preparing for combat trauma care at the individual provider level, the most critical training for a unit to prepare to handle combat casualties is triage and mass casualty management. This chapter will share triage and mass casualty expedients from three combat perspectives representing different echelons of care. Every trauma patient triggers a triage or sorting to align available resources with needs. But when those needs surpass apparent resources, we declare a MASCAL or mass casualty and launch a series of rehearsed strategies to achieve the greatest benefit for most patients. Intensity, number of casualties, and environment all contribute to this overload calculation: a single complex injury patient can eliminate a unit's ability to deliver additional casualty care, and two immediate surgical patients will max out many Level 2 facilities. Medical leaders can hone a unit's trauma-ready posture to expand its ability, as "chance favors the prepared team." This chapter reviews the "five Rs" to prepare a team for successful combat trauma response: resources, rehearsal, response, route, and reset.